Accidents with animals of medical interest in brazil winter school tropical diseases

1. Alexandre Naime Barbosa MD, PhD
Infectious Diseases Professor
Winter School on Tropical Diseases
Botucatu School of Medicine - UNESP
2019 - Botucatu - SP - Brazil
Accidents with Animals
of Medical Interest in Brazil

2. Content Declaration e Use of This Presentation
The following material is part of the educational project produced by
Prof. Dr. Alexandre Naime Barbosa
Objectives
1. Education: Training for Students & Health Professionals
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Authorship and Assignment
1. Content: The following data are referenced in respect to the original author;
2. Use: It is allowed to use the material, if the source is mentioned;
3. Contact: Talk to Dr. Barbosa and keep in touch with his project in:

3. Animals of Medical Interest in Brazil
1. The Brazilian Biodiversity
2. Amazon Biome
3. Pantanal Biome
4. Atlantic Forest Biome
5. Marine Biome
6. Conclusions

4. Animals of Medical Interest in Brazil
• Land area: 5th in the World, 3rd in Americas
• Climate: from equatorial to temperate
• Environment: from rainforests to deserts
• Ecosystems: highly diversified
• Perfect scenario for a huge biodiversity Wikipedia, 2013

5. Animals of Medical Interest in Brazil
• Brazil: 1st country in biodiversity
• Mammals: 689; Fish: over 3,000
• Birds: 1,832; Reptiles: 744
• Invertebrates: over 200,000
• Wildlife distribution: Biomes
Brazil Environment Ministry, 2011

6. Animals of Medical Interest in Brazil
• Biomes: six main regions
• Amazon: The biggest and most bio-diverse
• Pantanal: World's largest wetland area
• Atlantic Forest: A biodiversity hotspot
• Atlantic Ocean: Marine biodiversity
• Others: Caatinga, Savannah and Lowlands
Embrapa, 2012

7. Animals of Medical Interest in Brazil
1. The Brazilian Biodiversity
2. Amazon Biome
3. Pantanal Biome
4. Atlantic Forest Biome
5. Marine Biome
6. Conclusions

8. Animals of Medical Interest in Brazil
• Rainforest in the Amazon River Basin
• Equatorial Climate, hot and wet (rain)
• Venom: Snakes, Fish, Frogs and Invertebrates
• Trauma: Mammals, Reptiles, Fish and Invertebrates
WWF, 2014

9. Animals of Medical Interest in Brazil
Some Venomous and Poisonous Animals
1. Snakes: Bothrops sp.; Lachesis sp.
2. Fish: Stingrays, Catfishes
3. Frogs: Dendrobatidae Family
4. Invertebrates: Spiders, Scorpions, Bees, Ants, etc.
Haddad Jr et al. JVAT, 2013

10. Animals of Medical Interest in Brazil
Venomous Snake: Bothrops sp. (Jararaca, Jararacuçu, Urutu)
- 90% of Snakes Bites; over 60 species
- 70 centimeters to 2 meters
- Throughout Brazil
- Nocturnal, prefers wet places
Anacassia Lima, 2012

11. Animals of Medical Interest in Brazil
Venomous Snake: Bothrops sp. (Jararaca, Jararacuçu, Urutu)
- Proteolytic, Coagulant and Hemorrhagic
- Local edema, pain and necrosis
- Coagulopathy, bleeding and renal failure
- Fatality rate (Tx): 0,31 %, AV available
Anacassia Lima, 2012

12. Animals of Medical Interest in Brazil
Venomous Snake: Lachesis sp. (Surucucu)
- 1,5 % of Snakes Bites; 3 species
- 2 to 4 meters
- Amazon and Atlantic Forest
- Prefers dense forests
Anacassia Lima, 2012

13. Animals of Medical Interest in Brazil
Venomous Snake: Lachesis sp. (Surucucu)
- Proteolytic, Coagulant, Hemorrhagic and Neurotoxic
- Coagulopathy, bleeding and vagal hyperactivity
- Local edema, pain and necrosis
- Fatality rate (Tx): 0,95%, AV available
Anacassia Lima, 2012

14. Animals of Medical Interest in Brazil
Venomous Fish: Freshwater Stingrays (Arraia de Água Doce)
- Severe pain, local edema and erythema
- Cutaneous necrosis and secondary infection
- Lytic properties not fully studied
- Supportive therapy (hot water)
Haddad Jr et al. JVAT, 2013

15. Animals of Medical Interest in Brazil
Poisonous Frog: Dendrobatidae Family (Sapos/Rãs)
- Not venomous, but poisonous (skin)
- Toxicity through the consumption of small insects
- Produce one of the most lethal toxins
- Exposure: intentional, in rituals
The Sapo Diaries, 2013

16. Animals of Medical Interest in Brazil
Some Trauma Injuries by Animals
1. Mammals: Panthera onca, Tapirus terrestris, Myrmecophaga tridactyla
2. Fish: Vandellia cirrhosa, Electrophorus electricus
3. Reptiles: Eunectes sp., Black Caiman
4. Invertebrates: Blatella germanica
Voz do Acre Journal, 2012

17. Animals of Medical Interest in Brazil
Trauma Mammal: Panthera onca (Jaguar, Onça Pintada)
- Mainly in the Amazon and Pantanal
- Recently new cases in Brazil
- Ecotourism and Fishing tourism
- “Onça-seeing” tourism
Campos Neto et al. WEM 2011

18. Animals of Medical Interest in Brazil
Trauma Mammal: Panthera onca (Jaguar, Onça Pintada)
Predatory Attack 1: Non Fatal
- Fishermen boat, 17y/o man
- cranial-encephalic trauma
- brain and bone tissue loss, memory deficit
Campos Neto et al. WEM 2011

19. Animals of Medical Interest in Brazil
Trauma Mammal: Panthera onca (Jaguar, Onça Pintada)
Predatory Attack 2: Fatal
- Fisherman tent, 21y/o man
- cervical transection of the spinal cord
- cervical and brain tissue and bone loss
Campos Neto et al. WEM 2011

20. Animals of Medical Interest in Brazil
Trauma Mammal: Myrmecophaga tridactyla (Anteater or Tamanduá)
- Tamanduá: 2 meters, 40 kg
- Rare accidents
- 47y/o male hunter attacked by defense
- Death due to wounds in femural artery
Haddad et al. WEM 2014

21. Animals of Medical Interest in Brazil
Trauma Fish: Vandellia cirrhosa (Candiru)
- Small parasitic freshwater catfish, 12 cm
- Attracted by urine, enter through the urethra
- Umbrella-like spines, only removed after surgery
- Symptoms: pain and urethra bleeding FUNASA

22. Animals of Medical Interest in Brazil
Trauma Fish: Electrophorus electricus (Poraquê)
- Big freshwater knifefish, 2 - 3 meters
- Powerful electric shocks of up to 600 volts
- Shocks used hunting and self-defense
- 4,2% of all aquatic animals accident in a fishermen cohort
GarroneNeto et al. CSP 2005

23. Animals of Medical Interest in Brazil
Trauma Reptile: Eunectes sp. (Anaconda, Sucuri)
- One of the biggest snakes; 2 to 10 meters
- Non venomous
- Several reports of attacks to humans
- Only accidental attacks
The NYC, 2010
Google

24. Animals of Medical Interest in Brazil
Trauma Reptile: Black Caiman (Jacaré-açu)
- Not common, accidental
- 11y/o girl bathing on a river was attacked
- Many wounds and femur fracture
- Death due to drowning
Haddad Jr et al. WEM, 2011

25. Animals of Medical Interest in Brazil
Ueida et al. IJD 2013
Trauma Invertebrate: Blatella germanica (Cockroach, barata)
- Cockroach bites in massive infestation
- Poor sanitary conditions, indigenous people
- Secondary infections, allergy
- Cockroach can enter the ear, nose or mouth

26. Animals of Medical Interest in Brazil
1. The Brazilian Biodiversity
2. Amazon Biome
3. Pantanal Biome
4. Atlantic Forest Biome
5. Marine Biome
6. Conclusions

27. Animals of Medical Interest in Brazil
• Wetland in the Paraguay River Basin
• Tropical Climate, dry or rainy season
• Venom: Snakes, Fish and Invertebrates
• Trauma: Mammals, Reptiles, Fish and Invertebrates
IBAMA, 2013

28. Animals of Medical Interest in Brazil
Some Venomous Animals
1. Snakes: Bothrops sp.
2. Fish: Stingrays, Freshwater Catfish
3. Invertebrates: Spiders, Scorpions, Bees, etc.
Haddad Jr et al. RSBMT, 2012

29. Animals of Medical Interest in Brazil
Venomous Fish: Freshwater Catfish
P. Maculatus (mandijuba) and P. corruscans (surubim)
- Venomous stingers
- Pain, inflammation and bleeding
- Ulcer can be a complication
Haddad Jr et al. RSBMT, 2012

30. Animals of Medical Interest in Brazil
Some Trauma Animals
1. Mammals: Panthera onca, Tapirus terrestris, etc.
2. Fish: Serrasalmus sp.
3. Reptiles: Eunectes sp, Caiman sp.
Haddad Jr et al. RSBMT, 2012

31. Animals of Medical Interest in Brazil
Trauma Fish: Serrasalmus sp. (Piranha)
- No report of massive attack to humans
- Generally 1 single bite per person
- Outbreaks related to bathing
- Circular wound, laceration of tissues
Haddad Jr et al. WEM 2003

32. Animals of Medical Interest in Brazil
Trauma Reptiles: Caiman sp. (Jacaré do Pantanal)
- Very rare, accidental
- Fisherman 61y/o, only bite on hand
- Pain, blending, edema and secondary infection
- Trauma and hand fracture
Campos Neto et al. DT 2013

33. Animals of Medical Interest in Brazil
1. The Brazilian Biodiversity
2. Amazon Biome
3. Pantanal Biome
4. Atlantic Forest Biome
5. Marine Biome
6. Conclusions

34. Animals of Medical Interest in Brazil
• Tropical Forest in the Atlantic Coast
• Tropical and Subtropical Climate
• Venom: Snakes, Fish and Invertebrates
• Trauma: Mammals, Fish and Invertebrates
IBAMA 2013

35. Animals of Medical Interest in Brazil
Some Venomous Animals
1. Snakes: Bothrops sp.; Crotalus sp.; Micrurus sp
2. Fish: Stingrays, Freshwater Catfish
3. Invertebrates: Spiders, Scorpions, Bees, etc.
Butantan Institute

36. Animals of Medical Interest in Brazil
Venomous Snakes: Crotalus sp. (Cascavel)
- 7,7 % of Snakes Bites; 32 species (1Br)
- 50 centimeters to 1,5 meters
- Atlantic Forest, Cerrado, Caatinga
- Prefers rocky and dry places
Anacassia Lima, 2012

37. Animals of Medical Interest in Brazil
Venomous Snakes: Crotalus sp. (Cascavel)
- Coagulant, Miotoxic and Neurotoxic
- Bleeding, dark urine and myalgia
- Ptosis, myasthenic face and renal failure
- Fatality rate (Tx): 1,85%, AV available
CEVAP, 2011

38. Animals of Medical Interest in Brazil
Venomous Snakes: Micrurus sp (Coral)
- 0,4 % of Snakes Bites; 65 species
- 90 centimeters to 1,5 meters
- Thoughout Brazil
- Reclusive behavior, beneath the ground
M. M. Moura, 2012

39. Animals of Medical Interest in Brazil
Venomous Snakes: Micrurus sp (Coral)
- Neurotoxic only, but very potent
- Acute progressive myasthenic syndrome
- Paralysis of respiratory muscles, death
- Fatality rate: 0,36%; AV available Anacassia Lima, 2012

40. Animals of Medical Interest in Brazil
Venomous Invertebrates: Spiders
Phoneutria sp. (Armadeira)
- Agressive, 17 centimeters
- Neurotoxic venom, but in low dose
- Painful, dangerous to children, AV available
Funasa, 2009

41. Animals of Medical Interest in Brazil
Venomous Invertebrates: Spiders
Loxosceles sp. (Aranha marrom)
- Not agressive, 4 centimeters
- Necrotic venom
- Without acute symptoms, AV available
Funasa, 2009

42. Animals of Medical Interest in Brazil
Venomous Invertebrates: Scorpions
Tityus serrulatus (yellow) and T. bahiensis (brown)
- Local pain and inflammation
- Potential Neurotoxic Venom
- Dangerous to children, AV available
Funasa, 2009

43. Animals of Medical Interest in Brazil
Venomous Invertebrates: Caterpillar
Lonomia sp.
- Local pain and inflammation
- Hemorrhagic syndrome and Renal Failure
- Rare but possible deaths, AV available
SMS Curitiba, 2012

44. Animals of Medical Interest in Brazil
Venomous Invertebrates: Bees
Apis Mellifera (Africanized honey bees)
- 9,000 accidents/y, 26 deaths (2011)
- Complex venom, and allergic reaction
- No specific antivenom, supportive therapy
CEVAP, 2011

45. Animals of Medical Interest in Brazil
Some Trauma Animals
1. Mammals: Tapirus terrestris, Porcupines, etc.
2. Fish: Serrasalmus sp, etc.
Google

46. Animals of Medical Interest in Brazil
Trauma Mammals: Tapirus terrestris (Anta)
- Tapir: 2 meters, 200 kg
- Rare accidents
- 55y/o male farmer bitten three times
- Death due to bite in the cervical region Haddad Jr et al. WEM, 2005

47. Animals of Medical Interest in Brazil
Trauma Mammals: Porcupines (Ouriços-cacheiros)
- Porcupines: small rodent
- Rare accidents, non aggressive behavior
- 34y/o male tourist tried to capture
- After spines removed, the pain stopped
Haddad Jr et al. JVAT 2010

48. Animals of Medical Interest in Brazil
1. The Brazilian Biodiversity
2. Amazon Biome
3. Pantanal Biome
4. Atlantic Forest Biome
5. Marine Biome
6. Conclusions

49. Animals of Medical Interest in Brazil
• Extension: 9.198 km
• Climate: from equatorial to temperate
• Venom: Fish and Invertebrates
• Trauma: Fish and Invertebrates
Google

50. Animals of Medical Interest in Brazil
Some Venomous Animals
1. Fish: Stingrays, Marine Catfish and Scorpionfish.
2. Invertebrates: Sponges, Man-of-war, Jellyfish, Octopus and Sea Urchin
Google

51. Animals of Medical Interest in Brazil
Venomous Fish: Scorpionfish
Scorpaena sp. (Mangangá)
- Venomous stings in fin
- Strong and long pain
- Necrosis can be a complication
Brasil Reef

52. Animals of Medical Interest in Brazil
Venomous Invertebrates: Sponges
Tedania, Neofibularia and Microciona
- Irritating slime and spikes
- Allergic symptoms
Haddad, 2013

53. Animals of Medical Interest in Brazil
Venomous Invertebrates: Man-of-war
Physalia physalis, Caravela
- Small distal spicules
- Toxic and an allergic action
- Severe pain (like burning)
- Systemic repercussion
Haddad, 2013

54. Animals of Medical Interest in Brazil
Venomous Invertebrates: Jellyfish
Medusa, Água Viva
- Small distal spicules
- Toxic and an allergic action
- Severe pain (like burning)
- Systemic repercussion
Haddad, 2013

55. Animals of Medical Interest in Brazil
Some Trauma Animals
1. Fish: Moray eels (Muraenidae), Sharks, etc.
2. Invertebrates: Sea Urchin, Crabs, etc.
Haddad, 2015Google

56. Animals of Medical Interest in Brazil
Trauma Invertebrates: Sea Urchin
Ouriço do Mar
- Spine penetration and breaking
- Pain and Inflammation
- Granuloma and Secondary Infection
- Most common injury Haddad, 2013

57. Animals of Medical Interest in Brazil
• 1927-2015: 143 attacks (official data)
• Systematic report: only after 1992
• Main concentration in the Northeast Region
• Metropolitan area of Recife is the most affected
• Main species: Bull, Tiger, Sand Tiger and Great White

58. Animals of Medical Interest in Brazil
• 1927-1992: only 6 attacks in Pernambuco (official data)
• Systematic report: only after 1992
• 1992-2015: 60 attacks (until July 2015)
• Metropolitan area of Recife is the most affected
• Main species: Bull (cabeça chata) and Tiger (tigre)
Pernambuco State
CEMIT, 2013

59. Animals of Medical Interest in Brazil
• Shark Attacks in beaches
- Boa Viagem and Piedade: 69.4%
- Urban and crowded beaches
CEMIT, 2013
Google

60. Animals of Medical Interest in Brazil
• Deaths between 1992-2015:
- 24 deaths from 60 attacks reported
- Mortality rate: 40%
- Deaths by Exposure Category: Bathers = 83.3%
- 2012-2015 (until August): 5 attacks (4 fatal), 4 males, all bathers
- Cause of death: massive trauma injuries
CEMIT, 2013

61. Animals of Medical Interest in Brazil
• The most recent death, case report:
- 07/21/2013, Monday, 1:20 p.m.
- Boa Viagem beach, tourists in the water
- Two girls were taken by sea current to a deeper area
- Lifeguard was called due to drowning risk
- Trying to swim, an 18 y/o female was bitten by a shark Globo TV, 2013
OESP, 2013

62. Animals of Medical Interest in Brazil
• The most recent death, case report:
- Rescued from the water and taken to the hospital, 2 episodes of CRA
- Hypovolemic sock, BP: 0x0, unconscious
- Trauma lesion on the left leg
- Extensive blood, musculature and bone loss
- Amputation of the leg and all supportive therapies were performed
- Death after 10 hours of the attack
OESP, 2013
Restauração Hospital Archive

63. Animals of Medical Interest in Brazil
• Why are these attacks so frequent? General Reasons
- Same habitat: high population densities of sharks and humans
- Public warnings are constantly ignored, mainly by tourists
- Sea sports and other activities are increasing (e.g. surf)
- Splashing of arms and legs can attract sharks
- An occasional attack can be considered normal

64. Animals of Medical Interest in Brazil
• Why are these attacks so frequent? Specific Reasons
- High frequency of aggressive shark species
OESP, 2013

65. Animals of Medical Interest in Brazil
• Why are these attacks so frequent? Specific Reasons
- Topography: a deep channel, 100 meters of the shore
OESP, 2013

66. Animals of Medical Interest in Brazil
• Why are these attacks so frequent? Specific Reasons
1. Changes in the Suape
bay, a natural nursery of
aquatic life, in order to
build the port (1980) could
have dislodged the sharks.
2. Sharks usually follow the
ships
3. Waste and blood from a
slaughterhouse were thrown
into a close river.

67. Animals of Medical Interest in Brazil
1. The Brazilian Biodiversity
2. Amazon Biome
3. Pantanal Biome
4. Atlantic Forest Biome
5. Marine Biome
6. Conclusions

68. Animals of Medical Interest in Brazil
• In a continental country, huge biodiversity
• Many animal can be dangerous to humans
• Disturbs to the ecological balance = Accidents
• Research and learn with animals biology and behavior
• Fight against predatory exploration of the wildlife

69. Thank you for your attention!
SAE de Infectologia HC UNESP Botucatu Faculdade de Medicina UNESP